Multiple Cerebral Aneurysms Treated by Microsurgical and Endovascular Technique.

Treatment of multiple intracranial aneurysms is challenging. Neurologic status, aneurysm morphology, location, ruptured/unruptured status, availability of equipment, and patient preference are among the factors influencing the choice of treatment modality.1 Ideally, a 1-stage procedure is recommended whenever possible.2 However, patients with multiple aneurysms located in both the anterior and posterior circulation are less likely to be treated with a single procedure.3 We present the case of a 52-year-old patient who presented with recurrent headaches and progressive onset of a right eye ptosis evolving for 2 months. Her medical history was significant: an episode of eclampsia 20 years ago and high blood pressure managed with amlodipine. On physical examination, the patient was neurologically intact except for an isolated right eye ptosis. She had a brain angioscanner that revealed 1 right A1 aneurysm, 1 left M1 aneurysm, and 1 vertebrobasilar junction aneurysm. After discussion, we proposed a 2-stage procedure including a unilateral right pterional approach for right A1 and left M1 aneurysms and an endovascular treatment for the vertebrobasilar junction aneurysm. As illustrated in Video 1, both anterior circulation aneurysms were successfully clipped and the patient was discharged on day 4 with an intact neurologic status. Thirty days later, she underwent an endovascular coiling of the vertebro-basilar junction aneurysm uneventfully. She was able to return to work 2 weeks after discharge. The patient consented to publication of her images.

Early Experience of Endoscopic Endonasal Transphenoidal Surgery for Pituitary Adenoma: Preliminary Report of 56 Cases Operated in a West African Institution.

BACKGROUND: Although endoscopic endonasal approach (EEA) has been popularized worldwide for pituitary adenoma surgery, in sub-Saharan Africa, neurosurgeons are still only starting their experience with it. This study was designed to assess the early results of EEA for pituitary adenoma from an under-equipped environment, namely, the Department of Neurosurgery of the Teaching Hospital of Yopougon Abidjan and Bouaké in Ivory Coast. METHODS: The data of 56 cases of EEA for pituitary adenoma surgery performed between 2016 and March 2019 at the Teaching Hospital of Yopougon-Abidjan and Bouaké were retrospectively assessed. Pre- and postoperative neuro-ophthalmologic and hormonal status were analyzed. Moreover, the quality of tumor removal, and pre- and postoperative complications were also evaluated. RESULTS: In this study, there were nonfunctional adenomas (20), prolactinoma (18), Cushing disease (9), and acromegaly (3). A reduced visual acuity and/or visual field defect was observed in 49 cases. The mean operation time was 225 ± 94.7 minutes. The tumor removals were complete in 57.14%, subtotal in 35.71%, and partial in 7.14%. These led to a visual improvement in 69.64%. Postoperative complications were cerebrospinal fluid leaks (19.64%), diabetes insipidus (12.50%), visual worsening (7.14%), meningitis (3.57%), and carotid injury (3.57%) that led to death. CONCLUSIONS: This study represents the early surgical experience using EEA for treating pituitary adenoma in an under-equipped environment. Although the postoperative complication rate was relatively high, refinements of local surgeons' technique would lead to a better patient outcome.